What is the treatment for angular cheilitis?

Treatment of Angular Cheilitis

The first-line treatment for angular cheilitis is combination therapy with antifungal and corticosteroid components to address both infection and inflammation. 1, 2

First-Line Treatment Approach

• Combination therapy with antifungal and corticosteroid is most effective, with the antifungal component addressing Candida infection and the corticosteroid reducing inflammation and discomfort 1
• 1% isoconazole nitrate and 0.1% diflucortolone valerate ointment is particularly effective due to isoconazole's broad spectrum against dermatophytes and bacteria, combined with diflucortolone's anti-inflammatory properties 3

Alternative Topical Treatments

For primarily fungal infections:

• Apply nystatin oral suspension (100,000 units four times daily for 1 week) or miconazole oral gel (5-10 mL held in mouth after food four times daily for 1 week) 1, 2
• For resistant fungal cases, consider oral fluconazole (100 mg/day for 7-14 days) 1, 2

For primarily bacterial infection:

• Use antiseptic oral rinse containing chlorhexidine twice daily 1

Supportive Measures

• Apply white soft paraffin ointment to the lips every 2-4 hours to protect and moisturize 1, 2
• Maintain good oral hygiene with warm saline mouthwashes daily 1, 2
• For pain relief, use anti-inflammatory rinses with benzydamine hydrochloride rinse or spray every 3 hours, particularly before eating 1, 2
• Avoid alcohol-containing mouthwashes, which can cause additional pain and irritation 2

Addressing Underlying Causes

Angular cheilitis has a mixed etiology with both local and systemic factors that must be addressed for effective treatment:

• Evaluate and correct mechanical factors such as ill-fitting dentures or loss of vertical dimension 1
• Assess for systemic conditions such as diabetes or immunosuppression 1
• Consider nutritional deficiencies, particularly iron deficiency, which is an often overlooked predisposing factor, especially in women of childbearing age 4, 5
• Review medications that may contribute to the condition 1, 5
• Address habits like lip licking or mouth breathing 1

Treatment Duration and Follow-up

• If no improvement is seen after 2 weeks of treatment, reevaluate for correct diagnosis and patient compliance 1
• Immunocompromised patients may require more aggressive and prolonged therapy 1, 2
• Regular follow-up is essential to monitor treatment effectiveness and detect any complications 2

Special Considerations

• Angular cheilitis must be distinguished from actinic cheilitis, which is a premalignant condition requiring different treatment approaches 1
• Angular cheilitis has two age peaks: one during childhood and another in adults, becoming more frequent with aging 6
• Treating only the symptoms with antifungals without addressing underlying predisposing causes may lead to treatment failure 4